Purpose
To compare the efficiency of inferior rectus tucking versus combined superior rectus recession with posterior fixation suture (Faden) for the treatment of dissociated vertical deviation (DVD) without inferior oblique overaction.
Patients and methods
In this prospective study, 50 consecutive patients with DVD and without inferior oblique overaction were allocated randomly in their order of presentation to two groups; each group included 25 patients. The patients in group I were subjected to combined bilateral superior rectus recession and the Faden procedure (posterior fixation) and the patients in group II were treated by bilateral inferior rectus tucking (plication).
Results
DVD improved significantly (P < 0.05) in the two groups of the study. In group I, the mean vertical deviation improved from 18.21 ± 4.73 prism diopter (PD) preoperatively to 7.82 ± 5.61 PD 9 months after surgery (P < 0.05), with a mean correction of vertical deviation of 10.21 ± 3.52 PD and a mean correction of asymmetry of 2.1 ± 1.6 PD. Four patients needed inferior rectus tucking for residual or recurrent manifest DVD. In group II, the mean vertical deviation improved from 17.97 ± 6.89 PD preoperatively to 6.97 ± 5.46 PD 9 months after surgery (P < 0.05), with a mean correction of vertical deviation of 11.34 ± 2.71 PD and a mean correction of asymmetry of 2.5 ± 1.3 PD. Five patients needed inferior rectus retucking for residual manifest DVD.
Conclusion
Inferior rectus tucking is as effective as superior rectus recession with posterior fixation sutures for the primary treatment of DVD without inferior oblique overaction. Inferior rectus tucking can also be used effectively for the treatment of residual and recurrent DVD; further studies are recommended in this field.